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| HEALTH TRIBUNE | Wednesday, November 13, 2002, Chandigarh, India |
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Managing asthma with inhaler therapy Family income influences a child’s behaviour: study Kidney transplantation — II Emotional distress among twins a factor of ties with mothers INFO CAPSULE
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Managing asthma with inhaler therapy I convince my patients not to worry about the label, but it is essential to understand the need for regular treatment and checkups for a better quality of life and better control of the disease. I hand over the prescription and as soon as I utter the word “inhaler”, again the reaction is “no — I don’t need it. I don’t want to be dependent on it. I already told you that I was not all that bad.” I again explain, now with a pen and paper and with a diagram of airways in the lungs, how and why the airways get blocked; how the lungs have to struggle hard to get fresh air through those obstructions and how the inhaler is going to make medicine reach the place where its action is desired the most.” I emphasise again, “look, the inhaler is just a device for drug delivery. You put eyedrops in the diseased eye. Similarly, with the inhaler you are pushing the medicine into the inflamed airways where the effect is desired and nowhere else.” “No, it will be habit forming; it will cause side-effects”, prompt comes another argument. Yet another one is “Is mein to steroid hai (this is steroid). Please doctor we keep away from steroids even in the worst of circumstances in our family”. I do not lose my cool but explain to them how inhaled steroids are different from the steroids taken by other routes. Now I show them the latest write-up from a scientific journal which reads “Inhaled steroid is the corner-stone of therapy in asthma and it is this control of air-way inflammation which has made a decade of change in the management of asthma. They cut the risk of death from asthma. The beneficial effects of inhaled steroids are so compelling that they are recommended all over the world for regular therapy even in patients with mild persistent asthma.” The patient is somewhat convinced and pulls out one blue inhaler from his bag “I have already used it for more than a year but as soon as I stop it I am worst.” Now I explain to him the difference between blue inhaler, which can be asthalin or bricanyl, and the steroid inhaler. I ask him to always keep the blue inhaler in the pocket to tide over the emergencies only, which may sometimes come in spite of the use of the steroid inhaler. The education session now is about the difference in action of the two salts: the blue one is a bronchodilator and the brown is a repairer of inflammation. The patient firmly leaves after a lengthy and, perhaps, useful session and reaches the chemist. And I am surprised to get a phone call from the patient: “Jee, chemist ne bhi bola hai itni strong dawai! Ye to kharab karegi. The chemist told me that this is a strong medicine. It will harm me). I am really angry and want to blast the chemist, but keeping the decency of my profession in mind, I refrain from making any derogatory remarks. Instead, I ask him to give the phone to the chemist and tell him, “Mr so and so, give him this medicine and come to me whenever you have time to understand this form of treatment. Please send the patient back with the inhaler. “The patient comes back. I explain to him the proper inhalation technique, give him a write-up on what to do during an emergency at home and not to focus his attention on unnecessary cold and hot foods and the date of next follow-up. In the education material I have also included extracts from a scientific journal which reads like this: “Inhaled steroid therapy is unique in its proven effects in reducing asthma symptoms, improving airway caliber, airway responsiveness and the quality of life. These benefits occur at doses that are much lower than those associated with adverse effects. There is conclusive evidence that children even on long-term treatment with inhaled steroids attain normal adult height and women who have taken this for many years showed no loss of bone density.” The patient comes back smiling. He is happy with no emergencies. His life is better and he is on a regular treatment. Patient education is the most important part of asthma management. It is only through education that the various hurdles for a successful prescription can be crossed. The writer, a Chandigarh-based allergy specialist, was earlier associated with the PGI.
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Family income influences a child’s behaviour: study A
new study has revealed that stable family income promotes family literacy, reduces parental stress thus improving parenting, and provide affordable, high-quality child care, according to a report in the journal Child Development. "Countless studies have shown that family income is associated with children's development and educational attainment. Our findings suggest that family income influences children's cognitive ability and behavior through different pathways, which could be addressed by offering packages of family services," says the study's lead author, W. Jean Yeung of the Center for Advanced Social Research, Department of Sociology at New York University. Yeung, and colleagues M. Linver and J. Brooks-Gunn of Columbia University, studied data from a large, national survey to learn about the ways in which family income affects children's cognitive achievement and behavior problems. The study included 753 children who were between 3 and 5 years old in 1997. As expected, preschool children who lived in families with higher incomes scored higher on cognitive tests and had fewer behavior problems than those with lower family incomes. However, the researchers determined that family income may affect other aspects of child development, too. Much of the association between income and children's cognitive scores was rooted in the family's ability to provide a more stimulating learning environment. For example, higher income enabled parents to buy learning materials, engage in educational activities such as visits to museums, buy adequate food and pay for high-quality child care. On the other hand, the researchers found, the association between income and children's behavior was rooted in the level of economic pressure at home. Low-income mothers who faced economic instability were more likely to be emotionally distressed and to use punishment such as spanking. "If we want to improve young, low-income children's cognitive achievement, we should offer programs that seek to provide children with stimulating learning materials, increase family literacy, and encourage parents to read to their children or take them on educational outings, rather than focusing solely on parenting skills," Yeung explains.
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Kidney transplantation — II The motivation of a paid donor is not so easy to evaluate. The population willing to donate a kidney for money is a heterogeneous mix, and can be divided into three broad groups. The first group comprises young to middle aged illiterate males, usually landless labourers living in villages. Dissatisfied with their lot, they come to cities with the hope of finding better paying jobs. Such job-seekers, however, vastly outnumber the available jobs, and most of them find themselves without any work. Having exhausted their meager savings and being on the brink of starvation, they often do not have money even to go back home. At this point of time, they are approached by one of the agents who offer them money in exchange for one of their kidneys. Desperate and without any knowledge of the actual market value of the “reward” of their “gift”, they end up accepting whatever little is offered to them. The second group in the “donor market” comprises drifters and homeless people who are often addicted to alcohol and drugs and are not interested in work. Some of them are professional donors, who donate blood for money at privately run blood banks. There are numerous reports in medical literature of transmission of infections, including the dreaded hepatitis and human immunodeficiency virus (HIV), to previously negative recipients after a commercial transplant. In contrast to the illiterate villager, the professional donor has a better idea of the market price of his kidney, and bargains to get the most in this “once-in-a-lifetime” opportunity. Once this finite amount has been received and squandered away, this person may even try to extract more from the recipient, the middleman or the hospital where the transplant was performed. When rebuffed, some are known to approach the press or the police with the allegation that their kidneys have been removed without their knowledge or consent. Though the police in different parts of India has registered many such cases, perhaps none have been proved in courts so far. The third group comprises those who see kidney donation as a way to raise money to meet an immediate financial need. This could vary from paying off a debt, raising dowry for the marriage of a sister or a daughter, meeting the expenses for the treatment of a family member’s illness, house-building, or even buying a consumer item such as a scooter or a television set. Generally, these are the people in low-paying jobs, who have no other way of raising money quickly. This kind of donation has been dubbed “indirect altruism” because the ultimate beneficiary of the act of donation is not the kidney recipient (who is a stranger), but another person for whom the money has thus been raised. The increasing success rate of renal transplantation following the introduction of effective immunosuppressive drugs brought in new partners in the transplantation activity — the mysterious middlemen and touts. The clause in the Act permitting the transplantation of an organ from a living donor into the body of a recipient not being a near relative but out of love, affection and emotional attachment for the recipient, was immediately exploited by these middlemen who became involved in clinching deals between recipients and the donors, keeping a track of donors of various blood groups, informing the donors what is involved in the act of kidney donation and negotiating the price of the organ with the donor. They also assist the potential donors and recipients in preparing the affidavits to be submitted to the Authorisation Committee. Most of the affidavits contain identical language. Stories of exploitation of donors by middlemen have often appeared in the media from all over the country, especially Punjab, Karnataka and Tamil Nadu. Their activities have not only remained confined to India but have also spread to other countries as well. The recent exposure of a British scandal in which two Indian doctors have been acting as middlemen in supplying human organ for British patients, has attracted international attention. It is well known that the middlemen often corner the major chunk of money intended for payment to the donors by the recipients. It is not beyond anybody’s imagination that these middlemen have been enjoying the tacit support of private hospitals and transplant teams since without their help no transplant would take place. Dr Chugh is the Emeritus Professor of Nephrology and Dr Jha is an Associate Professor at the PGI, Chandigarh (To be concluded) |
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Emotional distress among twins a factor of ties with mothers Teen-age identical twins who are more religious and have closer relationships with their mothers and teachers are less likely to feel emotionally distressed than their twin sibling, according to a new research. "Adolescent monozygotic twins are quite similar considering that they are the same age, gender, ethnicity and social class, have the same parents, live in the same community, attend the same school and share genetically based traits", wrote researchers Robert Crosnoe of the University of Texas at Austin and Glen H Elder Jr of the University of North Carolina at Chapel Hill. However, the authors noted, "Considering the forces that promote twin similarity, one might be surprised at how different twins often turn out to be. In this study, twins differed in their feelings of emotional distress". The study looked at 289 identical twin pairs and emotional distress was measured by depressive symptoms such as feelings of guilt and hopelessness. Only 11 per cent of the twin pairs studied showed both twins having the same level of emotional distress. The twin who was less distressed tended to be closer to his or her mother and teachers. Girls were less distressed when they and their twin sisters had positive feelings about teachers.
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CAPSULE Washington This study may help researchers combat the harmful effects of stress. Lee Berk, Assistant Professor of family medicine and a researcher at the Susan Samueli Center for Complementary and Alternative Medicine, and his colleagues found that mere anticipation of a funny event reduced levels of stress-causing chemical messengers in the blood and increased the levels of chemicals known to reduce tension.
ANI Mental attitude and cancer London: A person's mental attitude does not affect his or her chances of surviving cancer, according to a new report in BMJ. For the study, the researchers reviewed 26 studies on the effect of psychological coping styles (including fighting spirit, helplessness/hopelessness, denial and avoidance) and survival from, or recurrence of, cancer. They found little convincing evidence that coping styles play an important part in survival from or recurrence of cancer. Good evidence is also lacking to support the view that "acceptance," "fatalism," or "denial" have an important influence on outcome.
ANI Schizophrenia drugs London: A new study has revealed that patients with schizophrenia who take antipsychotic drugs are more prone to have a cardiac arrest than non-schizophrenic patients, according to a report in BMJ. Researchers, by using data from three US Medicaid programmes, compared the frequency of cardiac events among patients with treated schizophrenia and control patients with psoriasis or glaucoma. To reduce cardiac risk, patients requiring thioridazine should be treated with the lowest dose possible to treat their symptoms, they said.
ANI Aspirin reduces ovarian cancer Washington: Aspirin may reduce ovarian cancer growth, a lab study by researchers at the University of South Florida has shown. The study demonstrated that aspirin inhibited ovarian tumour cell growth by as much as 68 per cent. The higher the dosage of aspirin added to the culture of ovarian cancer cells, the more growth inhibition was observed.
ANI Inflammatory proteins London: A new Swedish study has revealed that men with high blood pressure and inflammation are more than four times at the risk to suffer a stroke than other men, according to a report published in the Stroke. It was also found that inflammatory proteins in the blood play a major role in strokes, even 10 years after they are first detected.
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As soon as the diagnosis of asthma is uttered by the doctor, there is an immediate reaction of rejection by the patients. They come out with the expression, “It’s just cough. It’s not all that bad. Of course, it is in the family, but we don’t live with our father, etc.”